Hepatitis, often referred to as the “silent killer,” appears mostly as hepatitis B (HBV), for which a vaccine exists, or hepatitis C (HCV), which can be eliminated with antiviral drugs in more than 90 percent of chronically infected patients.
The Academies’ recommendations provide a framework for hepatitis elimination. The key, the Academies said, is to support prevention methods — vaccinations for HBV and antiviral drugs to treat HCV, combined with reducing exposure to the virus — with a major effort to identify and educate individuals with the virus.
“Many people suffering from viral hepatitis are not in contact with the health system, so the elimination strategy must give as much attention to the delivery of services as to the services themselves,” said Brian L. Strom, M.D., M.P.H., a renowned epidemiologist and the chancellor of Rutgers Biomedical and Health Sciences, who headed the committee of scientists selected by the Academies which studied the issue and developed the recommendations.
The committee’s recommendations also addressed the major costs of the antiviral drugs in light of the very expensive drug therapies which remain under patents. While these drugs are cost effective compared to other health interventions, the sheer cost of the drug has been “access prohibitive,” Dr. Strom said.
“The committee recommends a voluntary transaction between the government and the companies producing direct-acting antivirals, in which companies compete to license a patented drug to the federal government for use in neglected populations,” he explained.
The committee suggests licensing rights to the expensive drugs to treat vulnerable populations not currently reached through community health providers, such as prisoners and Medicaid beneficiaries.
Such an effort could cost approximately $2 billion, with states paying about $140 million, to reach an estimated 700,000 hepatitis patients, the committee said.
By comparison, currently it would cost approximately $10 billion over the next 12 years to treat only 240,000 patients among the prisoner and Medicaid populations, the Academies said.
“It is possible to eliminate hepatitis B and C as a public health problem in the United States, averting about 90,000 deaths by 2030,” Dr. Strom predicted.
Citing the importance of the issue, Strom noted that chronic HBV and HCV infections affect 3 to 5 times more Americans and 10 times more people worldwide than HIV. Viral hepatitis kills more people worldwide each year than HIV, road traffic injuries, or diabetes, Strom said.
Despite being the seventh-leading cause of death in the world, viral hepatitis consumes less than 1 percent of the National Institutes of Health research budget, Strom pointed out. Approximately 1.3 million Americans have HVB and 2.7 million have hepatitis C.
HVB and HVC account for approximately 80 percent of the world’s liver cancer. Chronic hepatitis B increases the odds of liver cancer 50 to 100 times, and of hepatitis C, 15 to 20 times, Strom said, adding that viral hepatitis is a driving factor in the 38 percent increase in liver cancer in the U.S. between 2003 and 2012.
Strom, a member of the Academies’ Institute of Medicine, has led several major institute projects, including the smallpox vaccination program implementation in 2002-2003 and the committee on dietary salt intake in 2012-2013.